Mental health articles

Akin to treatment planning, recovery planning involves developing goals and strategies for recovery, a collaborative process between the consumer and therapist. Contrasting recovery planning with the traditional mental health treatment planning, Davidson et al. (2009) emphasize that in recovery approaches consumers identify their goals and desires, while professionals help them remove barriers to these goals. Furthermore, recovery planning is person centered, rather than disease centered, meaning that not every goal is related to a symptom or problem—a tenetechoed by brief solution-focused therapists who have long claimed that the solution is not necessarily related to the problem (de Shazer, 1988). Also paralleling solution-based treatment planning,Wellness and Recovery Action Planning (WRAP; Copeland, 2000) promotes wellness usingJuly 2012 small, concrete steps.

Finally, the dictum in recovery planning is ‘‘nothing about us, without us’’(Davidson et al., 2009, p. 113), a collaborative therapy practice that is at the heart of Seikkula’s(2002) Open Dialogue approach in which all conversations about a consumer—including clinicalstaff meetings—involve consumers and significant persons in their lives.

Open Dialogue for Collaborative Planning

The Open Dialogue approach to working with psychosis and other psychiatric crises wasdeveloped inFinlandusing principles of collaborative therapy developed by Tom Andersen,Harlene Anderson, and Harry Goolishian (Haarakangas, Seikkula, Alakare, & Aaltonen, 2007;Seikkula, 2002). In this approach, once a call is received about a psychiatric crisis, a teamconsisting of a psychiatrist, therapist, and social worker is sent to the home within 24 hr; thisteam continues to work with the consumer until services have ended. The team asks to meetwith the consumer (typically unmedicated) and any significant people in the person’s life for aninitial meeting that lasts one-and-a-half hours.They begin by asking the consumer and the significant others about their concerns and how best to deal with them using a curious, nonassuming stance (Anderson, 1997). After45 min to an hour, the team has an ‘‘open’’ staff discussion in front of the family about their thoughts, concerns, and possible courses of actions while the family listens, using a reflecting team format (Andersen, 1991). After this discussion, the consumer and the significant others share their thoughts and reactions to the team’s discussion. From there, the team, consumer,and significant others work together to develop a plan that addresses the safety issues, preferences,and hopes that have been discussed. Together they decide whether hospitalization,medication, therapy, social services, and ⁄ or other options should be part of the recovery plan,the consumer’s desires, family’s preferences, and professionals’ opinions used to develop anarrangement that everyone believes is reasonable. This approach can be adapted for other contexts by maintaining the key elements of having ‘‘open’’ discussion about recovery options with consumers and their families and collaboratively working together to decide on the best course of action, even or especially in the case of a psychiatric emergency.

Collaborative Goal Setting and Risk Management

When promoting recovery, the goals should first and foremost target creating a meaningful life for the consumer, emphasizing wellness and broader areas of life functioning than therapeutic goals have done historically (Copeland, 2000). These meaningful goals may be ‘‘riskier’’(Davidson et al., 2009) than typical goals for persons diagnosed with severe mental illness and may include developing friendship networks, returning to work, changing living arrangements,and ⁄ or reducing medications: whatever the consumer believes would lead to a more satisfying life. Often the increased risk involves engaging in activities that may trigger symptoms or setbacks, which historically professionals have strongly advised against. For example, as notedearlier, in standard psychiatric practice, consumers were not encouraged to work until aftertheir symptoms were stabilized; however, such ‘‘risks’’ are encouraged if it is what the consumerdesires and if there are no imminent safety risks (Davidson et al., 2009). Goals should not beavoided if there is only a general concern of relapse and the client is willing to take that risk.Relapse prevention plans, symptom management plans, and ⁄ or safety plans must be in place ifriskier goals are pursued.

Micro-Steps

Once these broad, quality-of-life goals are set, therapists break these down into small,attainable goals, as advocated in solution-based therapy (Bertolino & O’Hanlon, 2002; De Jong& Berg, 2002). In Wellness and Recovery Action Planning, therapists work with consumers toidentify a ‘‘wellness toolbox,’’ a list of activities that a consumer identifies as helpful, as well asa daily maintenance plan that identifies how and when to use the activities (Copeland, 2000).Mapping out a daily maintenance plan involves helping the consumer plan his or her day,activity by activity, developing preventive measures for potential pitfalls. The key to recovery isoften found in making micro-adjustments to daily routines and habits that ultimately reducestress, ensure safety, and promote wellness. Similarly, small steps are identified to achieve long-term goals. For example, if a consumer wants to return to work, the first step may be showingup every day for a support group to work on attendance; then perhaps add volunteering; thenregistering for a job assistance program. The therapist’s role is to then do ‘‘whatever it takes’’to help achieve the goal, whether that involves assisting with filling out forms, identifyingcommunity resources, and ⁄ or looking up information on the Internet.

Tags: recovery, recovery planning